Today's Practice: Changing the Business of Medicine | Page 26

P RA CT I CE MA NA GE ME NT

High Cost of Turnover

Keith A. Herl, MHA, MBA | Matthew Mingenback

Turnover can cause a chain reaction profoundly
affecting care through:
Decreased patient satisfaction
Decreased patient access and increased patient wait times
Decreased patient throughput
Increased infection rates and hospitalizations for infection
Increased length of stay
Increased complication rates
Increased mortality
Increased malpractice claims
Conversely, organizations with lower rates of turnover were found to have providers who are more
engaged and satisfied with their jobs. Physician job
satisfaction has been strongly correlated to increased
patient satisfaction and a more positive perception of
patient care. Patients of satisfied physicians are also
more likely to remain in managed care plans and
adhere to medication, exercise and diet regimens4.

Diminishing Access
When providers leave practices, they often create a
care gap that takes anywhere from three to six
months to fill, if the role is filled at all. Once hired,
physicians take approximately 11 months to “settle
in.” NPs and PAs take up to 24 months to fully ramp
up. So when a provider leaves, it could be a
year-and-a-half to two years before the new provider
1
is at full productivity .
In some cases, a physician leaving means access dries
up altogether, and not just in rural areas. For
instance, if a community hospital loses their orthopedic group, it may be years before the hospital can
rebuild its orthopedic program, if at all.
The elderly are most affected by turnover as they

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tend to suffer from more complex health issues
that rely on continuity of care, have more difficulty finding transportation to their physician’s office
and fewer providers are accepting Medicare every
day.

How Can My Organization Promote
Proactive Retention?
Despite the huge, undisputable costs, most healthcare organizations don’t measure the impact of
turnover or have a proactive program in place to
retain their best providers. A 2015 study found
that only 24 percent of organizations attempted to
quantify the real cost of provider turnover, and
only 27 percent have a formal retention or
onboarding plan in place1.
Considering all the implications, this problem
deserves more attention.

Digging Deeper to Find the Cause
Identifying the true reason providers are leaving
can be particularly challenging as the exit process
is filled with emotion and biases that can affect
perceptions of the situation. The most common
reasons why providers leave their practice environment are:
Job dissatisfaction: Employee engagement and
satisfaction, or lack thereof, is a top predictor of
turnover1.
Cultural fit: If the provider’s personal and professional priorities and personality don’t mesh with
the organization, the provider is likely to leave or
be let go.
Burnout: Burnout now has its own CPT Code
(Z73.0). Forty-five percent of physicians reported
burnout in 2014 and most family medicine (68

TODAY ’ S P R A C T I C E: C H A N G I N G T H E B U S I NES S OF M EDI C I NE